Allegation

Your fitness to practice as a Social Worker is impaired by reason of your physical and/or mental health.

Finding

Preliminary Matters

1) Under the Health and Social Worker Order 2001 (as amended) there is no automatic right for a hearing relating to health issues to be heard in private. This being the case, the Council applied for the hearing to be heard in private so as to protect the private life of the Registrant.

2) The Panel was advised that there is a presumption that so far as possible hearings should be open and transparent and the subject of public scrutiny. It was therefore for the Panel to balance the Registrant’s right to a private life with this public interest.

3) The Panel considered this matter carefully and decided that as the evidence was almost exclusively related to the Registrant’s health, it was going to be practically impossible for the Panel to dissect the health issues and it would conduct the whole of the hearing in private.

4) There will therefore be two versions of the decision with written reference to the Registrant’s physical or mental condition being only referred to in the private edition.

5) At the start of the proceedings the Council applied for the physical/mental condition referred to in Schedule A to be amended to reflect the most recent diagnosis. The Registrant had been given notice of this change by way of letter dated 10 June 2014. The Registrant had not raised any objection or observation on this proposed change until the date of the hearing when she objected to the description of her condition as this did not accord with that given by her long-standing consulting clinician.

6) The Council argued that it was important that the nature of the medical condition was accurately described, and that the change of description reflected the evidence of the Council’s clinical expert, Dr Colgan. However, in view of the objections raised by the Registrant it was perhaps appropriate that the amendment of the allegation be stayed till after the evidence of the Council’s expert, when the question of the description of the diagnosis could be raised as a question with him by the Registrant. This being a matter where the amendment is not changing the nature of the allegation, it was submitted that there was no injustice in this instance in delaying the decision on this application until after the expert evidence had been heard.

7) The Panel heard from Dr Colgan.

8) The Panel accepted this expert evidence.

9) As this change of description of diagnosis did not prejudice the Registrant’s case, the Panel approved the application to amend the description.

Background

10) The Registrant started work at Salford City Council (SCC) on 2 July 2012 as a Grade 4A Social Worker in the Adult Safeguarding Review and Extra Care Team based within the Community Health and Social Care Department. She was employed on a fixed term contract (for twelve months) which was due to expire on 3 July 2013.

11) On 20 September 2012, the Registrant informed her line manager, Ms AB, that due to a health issue her driving licence was being revoked from Monday 24 September 2012.

12) Between 4 October 2012 and 8 October 2012, the Registrant had a period of sickness absence.

13) Around this time concerns arose about the Registrant’s ability to carry out her duties.

14) On 19 October 2012, the Registrant was told to go home sick and seek advice from her GP.

15) The first Sickness Absence meeting was held in line with SCC’s Attendance Management Policy. The second Sickness Absence meeting was held on 11 January 2012. The third Sickness Absence meeting was held on 26 February 2013. At none of these meetings did the Registrant acknowledge her mental health issues.

16) The Registrant was signed fit to return to work and began a phased return to work from 25 March 2013. Due to her sickness absence, the Registrant’s probation had to be extended because she had not completed the initial six month period that would have allowed SCC to review her performance.

17) There was a probationary review on 14 June 2013. The decision was made to extend the Registrant’s probation, but because of time constraints, it would not have been possible for the Registrant to meet the requirements needed before the end of her fixed term contract, which was due to end on 2 July 2913. The Registrant therefore left SCC on 2 July 2013.

18) The matter was referred to the HCPC.

Decision on Grounds

19) The Panel heard evidence from two live witnesses called on behalf of the Council.

• Ms AB, Team Manager of the Adult Safeguarding Review and Extra Care Team at SCC and who was the Registrant’s line manager during the time she worked there.

• The Panel had before it her sworn statement and the documentation that SCC had gathered as part of its management of the Registrant’s absences due to health issues and the assessment it had undertaken of her practice during her period of probation.

• Dr Stephen Colgan, Consultant Psychiatrist, and Honorary Associate Lecturer at the University of Manchester, who, on the instructions of Kingsley Napley solicitors, met with the Registrant on two occasions. He produced his expert witness statement and opinions based on those meetings and from reading the Registrant’s medical notes and records.

• The Panel had before it two reports prepared by Dr Colgan, dated 14 May 2014 and 21 January 2015 relating to the interviews he had had with the Registrant on 4 March 2014 and 20 January 2015.

• In addition Dr Colgan had the opportunity before the start of the hearing of speaking again with the Registrant.

• The Panel also had a further sworn witness statement from:

• JC, Human Resources Consultant with SCC. Her statement gave evidence of the process adopted by SCC in relation to the discovery and investigation of the Registrant’s health condition.

20) The Council’s witnesses gave evidence consistent with their written testimony.

21) AB presented as a credible and reliable witness and the Panel accepted her evidence that the Registrant at that time had been displaying elements of her health condition that had manifested themselves in the form of the Registrant’s lack of concentration and her inability to work at the pace required.

22) The Registrant gave oral evidence and within that was able to confirm the following:

• The change of medication has been beneficial and she is having weekly blood tests to monitor the possible side effects of this medication.

• She is being monitored by the Home Treatment Team.

• Her driving licence had been restored in December 2014, upon her being able to successfully demonstrate that she has been adhering to her programme of treatment.

• She is currently working as a care assistant in a residential care home. She started in this position in December 2014. She is enjoying her role and is able to discharge her duties.

• Her current employer does not know that she has a health condition and is not aware of this hearing. The Registrant emphasised that she did not consider her health condition was one that she had to tell her employer about, and that it had no bearing on her responsibilities in that post.

• Although she still finds it embarrassing to talk about what happened to her, she is now able to do so, which indicates that she has made progress towards acknowledging and dealing with her health condition.

• She hoped to return to her profession in the future and had become a Social Worker because she enjoyed helping people. She had enjoyed working with the elderly when she was working in Bolton and saw herself returning to this area of practice.

23) The Registrant’s father, NST, also gave evidence. In his view his daughter’s recovery was nearly complete: he had seen a ‘massive’ change in her since the problems arose in 2011, and that she is now a ‘whisker away from her old self’. When questioned on this he expanded by saying that his daughter’s return to work would be the most beneficial thing she could do.

24) At this stage in the proceedings there is no onus on the Council. It is a matter for the judgment of the Panel as to whether the factual and medical information before it supports a finding of a current and continuing health condition.

25) The Panel took into account the representations of the parties. It accepted the advice of the Legal Assessor and it considered the advice published in the Council’s Practice Note.

26) The Panel had evidence that the Registrant’s onset of symptoms were first identified by the Registrant on 9 June 2011.

27) The Panel accepted the written and oral evidence of Dr Colgan that there was, and is, evidence of a continuing health condition. The letter dated 7 May 2015 from the Early Intervention Team confirmed the Registrant was compliant with all aspects of her treatment.

28) The Panel finds that the ground of health has been established.

Decision on Impairment

29) In reaching its decision the Panel took into account the following:

• In relation to impairment, the Panel reminded itself that the test of impairment is expressed in the present tense, that fitness to practise ‘is impaired’.

• Whether the Registrant’s fitness to practise is impaired is a matter of judgment for the Panel.

• The guidance issued by the Council in its Practice Note entitled Health Allegations.

• The guidance issued by the Council in its Practice Note entitled ‘Finding that fitness to practise is impaired.’

30) The Panel has evidence before it that the Registrant is still under the care of the Home Treatment Team. The Registrant’s medication had been changed as recently as January 2015.

31) The Panel heard that it was still too soon to make a full assessment as to whether this medication was providing the requisite level of support or whether a review would disclose the need for further adjustment of dose or type of medication. In Dr Colgan’s view twelve months on this medication would be a better guide as to whether it was the appropriate medication and to identify the optimum dosage. However, on the presentation of the Registrant today it appeared to Dr Colgan that there had already been an improvement.

32) The Panel has no current professional or personal references before it.

33) The Panel has been told by the Registrant that she is working without concern at present, however her employer is not aware of her health condition, nor of these proceedings.

34) The Registrant has told the Panel that she would continue with her treatment. However, there is evidence that previously she unilaterally made a decision to stop her medication and stated she continued with her medications because others wished her to do so.

35) The Registrant also confirmed that she would, when applying for a Social Work position, tell a future employer that she had a health condition because this would be part of an Occupational Health questionnaire. There is, however, evidence that she had been reluctant to inform her employer, SCC in 2012 of her health condition, and, as noted above, the Registrant’s current employer has not been informed. The Panel therefore has some concerns about the true level of insight that the Registrant has gained into the nature of her condition and the need for disclosure.

36) The Panel had evidence that since leaving Bolton in 2007 the Registrant had only worked for a few months as a Social Worker. This was the period when she was at SCC. However during this period of twelve months employment, there had been a significant period of absence due to illness. Since 2007 the Registrant has not undertaken any structured continuing professional training or development. However, she told the Panel that she had made some efforts to maintain her professional knowledge by reading relevant journals and white papers. Notwithstanding these statements, the Panel had no further evidence of how the Registrant had maintained her professional knowledge.

37) Given these factors, the Panel has come to the conclusion that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction

38) The Panel is mindful that in a case involving a health condition the provisions of Article 29(6) of the Health and Social Work Order 2001 (as amended) provide that the Registrant cannot be struck from the register unless and until they have been the subject of a continuous period of conditions of practice or period of suspension in excess of two years following a substantive hearing. This being the case, this Panel does not have the right today to remove the Registrant’s name from the Register on a permanent basis.

39) In a matter involving health, the Panel is also conscious of the fact that the sanction should not be seen to be a punishment nor is it intended to be punitive in nature but to provide a means by which the Registrant may be able to return to safe practice, if there is a possibility of this, at some point in the future.

40) The Registrant told the Panel that she currently worked with some people with dementia and had acquired transferable skills. She told the Panel she would continue to see her consultant on a regular basis and engage with her mental health team.

41) The Panel took into account the views of Dr Colgan on this issue. He is of the professional opinion that the Registrant should not be returned to a stressful and pressurised social work environment at this moment or until she has demonstrated that the medication regime she is following has been able to address and control her health condition.

42) The Panel therefore considered that some form of restriction was required not only for service user protection but in the Registrant’s own interests too. The Panel heard that the Registrant had only worked part of her one year contract at SCC and apart from this had been out of practice since 2007. This was another factor that needed to be addressed before the Registrant returned to unrestricted practice.

43) Taking into account the guidance in the HCPC Indicative Sanctions Policy, the Panel came to the following conclusions:

44) Taking no further action was not in the public interest, nor in the Registrant’s.

45) Mediation was inappropriate in this case.

46) The imposition of a Caution Order would not provide any level of service user protection nor would it provide any support for the Registrant; moreover it would not protect the Registrant from exposure to the stressful elements of social work that may exacerbate her health condition.

47) The Panel gave careful consideration as to whether there were any Conditions of Practice that would both provide the support required by the Registrant and the appropriate level of service user protection required, whilst the Registrant was regaining her skills and knowledge that had been lost over time, to enable her to regain her levels of professional confidence. The Panel came to the decision that it could not without them being so restrictive that they would be unworkable as conditions.

48) In addition, the Panel had sufficient continuing concerns about the Registrant’s control and management of her health condition such that this issue needed to be demonstrably addressed before she returned to the pressurised environment of social work. The Panel noted there had been no actual service user concerns or known harm to service users arising out of the Registrant previously practising during a period when she was not controlling her health condition, but there was the potential for service user harm. The Panel considers that the Registrant was very unlikely to present a direct risk of harm to service users by either making threats or acting in a violent manner: however the Panel was concerned that if the Registrant experienced further florid symptoms of her illness she may be so distracted that she was rendered unable to prioritise the needs of vulnerable service users. This potential should so far as possible be reduced.

49) The Panel therefore came to the conclusion that a period of suspension was appropriate and proportionate at this time. This would enable the Registrant to demonstrate that she has regained her skills and knowledge and that she has successfully addressed and is managing her health condition before returning to practice. The Panel has therefore decided that a period of suspension for twelve months would provide the Registrant with the opportunity of providing evidence on these issues.

50) As stated above, a striking off order is not available to this Panel. However notwithstanding this, this Panel considers that such a sanction would, if available, have been inappropriate and disproportionate given the strides the Registrant has made in recent years to address and control her health condition. Further, given her continued desire to return to her chosen profession and to provide care for others in the future it would not be in the public interest for her to leave her profession.

51) This Panel considers that a future reviewing Panel would be assisted by evidence produced by the Registrant of all, or any, of the following:

• That she has continued to adhere to her treatment plan as directed by her mental health team.

• Evidence of any further insight gained by her into the nature of her health condition, or the ways in which her health condition manifested itself during the period 2011 to 2013.

• Evidence of further professional reading and learning.

• Evidence of courses attended relevant to the social work profession.

• Evidence from those with whom she has worked recently as to her abilities and professional qualities. In particular testimonial(s) from her employer as to whether she has been able to discharge the responsibilities of her current role as a care assistant.

• Confirmation from any new employer that the Registrant has disclosed her health condition at the time of taking up her position.

• Evidence of any work undertaken within a social work environment.

• References from friends, relatives, former colleagues, and/or a personal mentor, of the ways in which the Registrant has regained her self-confidence, and, in particular, is now able to engage in discussion about her health condition.

• Reports from a fellow professional who, either in the role of a professional mentor, or informal supervisor, has had regular meetings with the Registrant to discuss matters relating to her profession and her professional responsibilities and knowledge.

52) Before any review of this suspension order the HCPC is to secure a further report from Dr Colgan.

53) The Panel gave consideration as to whether the Registrant should be able to return for an early review of her period of suspension. It came to the decision that the registrant was unlikely to be able to provide the requisite medication evidence and proof of learning within a period of six months. The Panel has therefore prescribed under article 29(7)(b) that a review should not be allowed within six months.

Order

Order: The Registrar is directed to suspend the registration of Nichola Taylor for a period of twelve months from the operative date, such suspension not to be reviewed until the lapse of six months.

Notes

A Final Hearing took place at the Thistle in Manchester on Monday 08 June to Wednesday 10 June 2015.